Will he get back to normal? survival and functional status after intensive care therapy

The study aim was to address healthcare workers’ and patients’ questions about the likely level of recovery at 6 months of patients admitted to an Australian intensive care unit (ICU). Ninety-three consecutive, eligible adults were identified and followed prospectively. Severity of illness on admission was assessed using Acute Physiological and Chronic Health Evaluation (APACHE II), while functional status at 6 months was evaluated using the Sickness Impact Profile (SIP). Cumulative mortality was 25%. Admission severity of illness was associated with survival at 6 months (P≤0.001). Fifty-one (78%) of the 70 survivors were interviewed. Admission severity of illness scores correlated with functional status at 6 months (r=0.34, P=0.01), a finding reported in only one other study. More than half of those interviewed had returned to near pre-admission functional status. Those with poor functional status included high proportions of people with chronic illness and head injury. Overall, physical recovery was more complete than psychosocial recovery. The findings provide useful information for addressing questions relating to physical and psychosocial recovery, appetite, sleep patterns and return to work post discharge.

Returning to work: exploring the experiences of women with acute coronary syndromes

Aims: The aim of this study was to explore the transition experiences of Australian women in resuming paid employment after an acute coronary syndrome (ACS) event. Background: Until recently cardiovascular research has focused predominantly on men but this is changing and research exploring women’s experiences of ACS has increased. Despite knowing that many women do not resume paid employment following an ACS event, little is known about the experience of those women who do, even though it is understood that returning to the previous level of employment after an ACS event is a positive outcome. Design: An exploratory qualitative approach underpinned by naturalistic inquiry was undertaken. Methods: A purposive sample of seven women who had experienced their first ACS event 12 months ago was selected. Each woman was interviewed using a semi–structured format and their interviews were transcribed verbatim. Thematic analysis of the transcript set and conceptual mapping were employed to formulate key themes. Findings: All women (mean age 52.6 years) resumed paid employment at various stages during their recovery, but reported similar transition processes. Three key themes representing this process were identified: primary motivation; influence through guidance and support; and resuming paid employment. Conclusions: Study findings revealed that these women required substantial support from family, friends and employers, with ongoing guidance from health professionals to return to paid work. The time frames for their return varied and some modified their roles within the workforce to enable them to return to paid work. However, formal cardiac rehabilitation did not appear to have a significant impact on these participants' decisions to return to work. They felt that more information about this decision may have been helpful if given at the time of cardiac rehabilitation.

SME myths: if we put up a website customers will come to us-why usability is important

Many businesses use their Websites primarily as an alternative marketing strategy. How a business’s image, via a Website, is presented to potential customers is therefore important. There are many factors that will influence the effectiveness of a Website, two critical factors are how easily users are able to navigate and how easy the site is to use. The research reported here examined these two factors on users’ responses to small and medium-sized business Websites. The research found that the quality of navigation and how easy a site is to use does have an impact, how much information is read, the importance of the graphical components, a user's emotional response to a Website, users’ frustration and the user’s intention to return to that Website. The research established the statistically significant elements that contribute to navigation and ease-of-use, and describes the design and successful application of a usability evaluation instrument.

Skill shortages in health : innovative solutions using vocational education and training

Introduction: This article reports findings of a project funded by the Australian National Council for Vocational Education Research. The project explores solutions to current and projected skills shortages within the health and community services sector, from a vocational education and training perspective. Its purpose is to locate, analyse and disseminate information about innovative models of health training and service delivery that have been developed in response to skill shortages.

Methods: The article begins with a brief overview of Australian statistics and literature on the structure of the national health workforce and perceived skill shortages. The impact of location (state and rurality), demographics of the workforce, and other relevant factors, on health skill shortages is examined. Drawing on a synthesis of the Australian and international literature on innovative and effective models for addressing health skill shortages and nominations by key stakeholders within the health sector, over 70 models were identified. The models represent a mixture of innovative service delivery models and training solutions from Australia, as well as international examples that could be transposed to the Australian context. They include the skill ecosystem approach facilitated by the Australian National Training Authority Skill Ecosystem Project. Models were selected to represent diversity in terms of the nature of skill shortage addressed, barriers overcome in development of the model, healthcare specialisations, and different customer groups.

Results: Key barriers to the development of innovative solutions to skills shortages identified were: policy that is not sufficiently flexible to accommodate changing workplace needs; unwillingness to risk take in order to develop new models; delays in gaining endorsement/accreditation; current vocational education and training (VET) monitoring and reporting systems; issues related to working in partnership, including different cultures, ways of operating, priorities and timelines; workplace culture that is resistant to change; and organisational boundaries. For training-only models, additional barriers were: technology; low educational levels of trainees; lack of health professionals to provide training and/or supervision; and cost of training. Key enhancers for the development of models were identified as: commitment by all partners and co-location of partners; or effective communication channels. Key enhancers for model effectiveness were: first considering work tasks, competencies and job (re)design; high profile of the model within the community; community-based models; cultural fit; and evidence of direct link between skills development and employment, for example VET trained aged care workers upskilling for other health jobs. For training only models, additional enhancers were flexibility of partners in accommodating needs of trainees; low training costs; experienced clinical supervisors; and the provision of professional development to trainers.

Conclusions: There needs to be a balance between short-term solutions to current skill shortages (training only), and medium to longer term solutions (job redesign, holistic approaches) that also address projected skills shortages. Models that focus on addressing skills shortages in aged care can provide a broad pathway to careers in health. Characteristics of models likely to be effective in addressing skill shortages are: responsibility for addressing skills shortage is shared between the health sector, education and training organisations and government, with employers taking a proactive role; the training component is complemented by a focus on retention of workers; models are either targeted at existing employees or identify a target group(s) who may not otherwise have considered a career in health.

Descriptive epidemiology of Australian football injuries presenting to sports medicine clinics

Sports injury prevention has been the focus of a number of recent public health initiatives due to the acknowledgement that sports injuries are a significant public health problem in Australia Whilst Australian football is one of the most popular participation sports in the country, only very limited data is available about football injuries The majority of sports injury data available for this sport is from hospital emergency departments and elite-level injury surveillance Overall there is a paucity of data from treatment settings other than hospitals In particular, there is a lack of information about the injuries sustained by community-level, junior and recreational Australian football participants. One good potential source of football injury data is sports medicine clinics. Analysis of injury presentations to sports medicine clinics was undertaken to provide a detailed description of the epidemiology of Australian football injuries that present to this treatment setting and to determine the implications for injury prevention in this sport. In addition, the data from sports medicine clinics was compared with existing sources of Australian football injury data to determine how representative sports medicine clinic data is of other football injury data sources and to provide recommendations for future injury surveillance n Australian football. The results contained in this thesis show that Australian football is the sport most associated with injury presentation at sports medicine clinics. The majority of injured Australian football players presenting to sports medicine clinics are community-level or junior participants which suggests that sports medicine clinics are a good source of information on the injuries sustained by sub-elite football participants. Competition is the most common context in which Australian football players presenting to sports medicine clinics are injured. The major causes of injuries to Australian football players are being struck by another player, collisions and overuse. Injuries to Australian football players predominantly involve the lower limb. Adult players, players who stopped participating immediately after noticing their injury and players with overuse injuries are the most likely to sustain a more severe injury (i.e. more than four weeks before a full return to football participation and a moderate/significant amount of treatment expected). The least experienced players (five or less years of participation) are more likely to require a significant amount of treatment than the more experienced players. The prevention of lower limb injuries, injuries caused by body contact and injuries caused by overuse should be a priority for injury prevention research in Australian football due to the predominance of these injury types in the pattern of Australian football injuries Additionally, adult players, as a group, should be a focus of injury prevention activities in Australian football due to the association between age and injury severity. Overall, the pattern of Australian football injuries presenting to sports medicine clinics appears to be different than reported by club-based and hospital emergency department injury surveillance activities. However, detailed comparison of sports medicine clinic Australian football data with other sources of Australian football injury data is difficult due to the variable methods of collecting and reporting injury information used by hospital emergency department and club-based injury surveillance activities. The development of a standardised method for collecting and reporting injury data in Australian football is strongly recommended to overcome the existing limitations of data collection in this sport. In summary, sports medicine clinics provide a rich source of Australian football injury data, especially from the community and junior levels of participation. The inclusion of sports medicine clinic data provides a broader epidemiological picture of Australian football injuries. This broader understanding of the pattern of Australian football injuries provides a better basis for the development of injury prevention measures in this sport.

Does Australia's treatment of non-citizens accord with its international human rights obligations? with specific reference to the treatment of on-shore refugees

The son of immigrants, I was motivated to write a paper addressing the issues of alienation and discrimination which confronts non-citizens upon arriving in Australia. Apart from descendants of Australia's indigenous population, the common bond shared by all citizens and permanent residents of Australia is that they are either themselves immigrants or are descended from immigrants. In this paper I will look at whether Australia's law and practice meets its international human rights treaty and convention obligations vis-a-vis non-citizens. To investigate this issue I trace the history of immigration to Australia and look at the political policies which influenced the treatment of non-citizens from 1788 to present times. In 1958 when my parents stepped upon Australian soil as displaced persons, Australia was a very different place from Australia in the 1990s. At that time Australia was still firmly under the influence of the 'White Australia Policy' which openly encouraged discrimination against non-anglo saxons. Since those times Australia has advanced to become one of the most culturally diverse nations in the world where multiculturalism is encouraged and a non-discriminatory immigration program is supported by both Australia's major political parties. However, notwithstanding the great social advances made in Australia in recent decades the traditional legal sources of law, namely, judicial pronouncements, statutes and the Commonwealth Constitution have not kept pace and it is my submission that Australia's body of law inadequately protects the rights of non-citizens when compared to Australia's international human rights convention and treaty obligations. This paper will consider these major sources of law and will investigate how they have been used in the context of the protection of the rights of non-citizens. It will be asserted that the weaknesses exposed in the Australian legal system can be improved by the adoption of a Bill of Rights1 which encompasses Australia's international human rights treaty and convention obligations. It is envisaged that a Bill of Rights would provide a framework applicable at the State, Territory and Federal levels within which issues pertaining to non-citizens could be resolved. The direction of this thesis owes much to the writings, advice and supervision of Dr. Imtiaz Omar who was always available to discuss the progress of this work. Dr. Omar is a passionate advocate of human rights and has been a tremendous inspiration to me throughout my writing. I owe a debt of thanks to the partners of Coulter Burke who with good nature ignored the sprawl of books and papers on the boardroom table, often for days at a time, thus enabling me to return to my writing from time to time as my inspirational juices ebbed and waned. Thanks also go to my typists Julie Pante, Vesna Dudas and Irene Padula who worked after hours and on weekends always without complaint, on the various versions of this thesis. My final acknowledgement goes to my wife Paula who during the years that I was working on this thesis encouraged me during my darker moments and listened to all my frustrations yet never doubted that I would one day complete the task successfully. I wish to thank her wholeheartedly for her motivation and belief in my abilities. The law relied upon in the thesis is as at the 30th June, 1998. Bill or Charter of Rights 'are taken to be enactments which systematically declare certain fundamental rights and freedoms and require that they be respected'. See Evans, G. 'Prospect and Problems for an Australian Bill of Rights' (1970) 3 Australian Year Book of International Law 1 at 16. Some such notable exception is the New Zealand Bill of Rights Act 1990, contained in an ordinary statute.

'By the facts we add to our store' : Lorimer Fison, Lewis Henry Morgan and the spread of kinship studies in Australia

The formal study of kinship was introduced to the South Pacific Islands and the Australian colonies by Methodist missionary Lorimer Fison who distributed schedules and collected kinship data from around the region in collaboration with the founder of Anthropology in America, Lewis Henry Morgan. This article is a sequel to H. Gardner, 2008 'The origins of kinship in Oceania', Oceania, 78:2, 137-150. It traces Lorimer Fison's return to the Australian colonies from his mission post in Fiji and the subsequent spread of kinship schedules to settlers, missionaries and administrators around Australia. Based on unpublished correspondence, the article investigates Fison's gradual disillusionment with Morgan's evolutionist hypothesis of the development of the human family and his disdain for the speculation of much metropolitan anthropology in the 1870s.

The fur seal — a model lactation phenotype to explore molecular factors involved in the initiation of apoptosis at involution

Mammary gland involution requires co-ordination of milk production, immune responses, apoptosis and remodeling. Initiation and progression of each of these components involves integral control by the mammary gland. Although cell-based culture models and genetically manipulated animals have shed light on these processes, the factors controlling each step in the involution cascade are still poorly understood. The fur seal displays a unique lactation phenotype. During the lactation cycle the mammary gland downregulates milk production and initiates an immune response but fails to initiate the apoptotic phase of involution, allowing the female fur seal to undertake long foraging trips of up to 28 days between suckling bouts. Upon return to shore the female continues feeding her pup following resumption of lactation and milk production. Expression profiling of genes involved in this lactation cycle provides valuable tools for investigation of the factors responsible for the initiation of apoptosis at involution.

Letter to a dead playwright : daily grind, Vicki Reynolds and archive fever, part 2

'Nothing is less reliable, nothing is less clear today than the word "archive",' observed Jacques Derrida in his book Archive Fever, a Freudian Impression (1996). This paper reflects on the unsettling process of establishing (or commencing) the Melbourne Workers Theatre archive, which is part of the ARC funded AusStage project. It does so with reference to Derrida's account of archive fever, which he characterises as an 'irrepressible desire to return to the origin, a homesickness, a nostalgia for the return to the most archaic place of absolute commencement' (91). In short, the paper uses Derrida's commentary on questions of memory, authority, inscription, hauntology and heritage to identify some of the philosophical and ethical aporias I have enountered while working on the AusStage project. The paper pays particular attention to what Derrida calls the spectral structure of the archive, and stages a conversation with the ghosts that haunt the digitised Melbourne Workers Theatre documents. It also unpacks the logic of Derrida's so-called messianic account of the archive, which 'opens out of the future' thereby affirming the future-to-come, and unsettling the normative notion of the archive as a repository for what has passed.

Ability of predator odour exposure to elicit conditioned versus sensitised post traumatic stress disorder-like behaviours, and forebrain ΔFosB expression, in rats

At present, exposure of a rodent to the odour of a predator is one of the most common animal models of post traumatic stress disorder (PTSD). Despite this, the model remains incompletely characterized, particularly in regard to within subject assessment of major PTSD-like behaviours. In an attempt to redress this situation, we have extensively characterized the two broad categories of behaviour that are considered to characterize PTSD, that is sensitized behaviours such as social withdrawal and hypervigilance and conditioned behaviours such as avoidance of trauma linked cues. Specifically, we determined the presence and duration of both conditioned and sensitized behaviours, in the same cohort of animals, after three exposures to predator odour. Conditioned fear was assessed on the basis of inhibition of locomotor activity upon return to context 2, 7, 14, 21, and 28 days after the last odour exposure session. To assess the impact on sensitization behaviours, we monitored acoustic startle responses and social interaction behaviour 4, 9, 16, 23, and 30 days after the last exposure session. In addition to examining the behavioural consequences associated with odour exposure, we also determined the key brain regions that were activated using ΔFosB immunohistochemistry. Our results show that the two groups of behaviours thought to characterize PTSD (conditioned and sensitized) do not travel together in the predator odour model, with clear evidence of enduring changes in conditioned fear but little evidence of changes in social interaction or acoustic startle. With regard to associated patterns of activity in the brain, we observed that odour-exposed animals exhibited significantly higher numbers of FosB-positive nuclei in only the medial prefrontal cortex (mPFC), a finding that can be viewed as being consistent with the observed behavioural changes.

Individual differences predict susceptibility to conditioned fear arising from psychosocial trauma

Background : Classical Pavlovian fear conditioning has been widely used in preclinical studies to gain insights into anxiety-related disorders. In this study we examined whether pre-existing behavioral differences, and/or behavioral differences displayed during fear induction, predict the severity of the conditioned fear response that can develop after an episode of psychosocial conflict.

Methods : Prior to conditioning, male rats (intruders) were behaviorally assessed using the novel environment exploration and defensive burying tests. These animals were subsequently placed in the territory of an older male (resident) that invariably attacked the intruder.

Results : Upon return to this territory 24 h later, intruders moved less than controls and produced more distress vocalizations, indicating conditioned fear to context. Additionally, analyses revealed that both pre-existing behavioral differences, and the animal’s response during social conflict, predicted the magnitude of the subsequent conditioned fear response. Specifically, animals that engaged in higher levels of novel environment exploration, that exhibited a greater number of defensive burying behaviors, and that demonstrated higher levels of fighting and guarding during social conflict, displayed less evidence of conditioned fear.

Conclusion : These findings show that the behavioral variability existent within a normal outbred population can predict the magnitude of the conditioned fear response.

Strain differences in coping behaviour, novelty seeking behaviour, and susceptibility to socially conditioned fear : a comparison between Wistar and Sprague Dawley rats

The aim of the current study was to generate socially conditioned fear in two different strains of rat (Wistar, W and Sprague Dawley, SD) using social conflict, in order to investigate whether the magnitude of the conditioned fear responses in each strain was related to behaviour exhibited prior to or during fear induction (i.e. social conflict). On day one of the study, all intruders were assessed for exploratory activity in a novel environment. Twenty four hours following the novel environment test the locomotor activity of the intruders was assessed, while they underwent a single familiarisation exposure to the arena in which the conflict was subsequently to occur in. Twenty-four hours following familiarisation, intruders underwent either a 10 min social conflict or sham conflict session. One day later we examined the response of the intruders when they were returned to the vacant resident's cage. Upon return to the conflict context, we examined the intruder's ultrasonic distress vocalisations and the extent to which locomotor activity was inhibited. We found that W rats displayed significantly more immobility (i.e. conditioned fear) upon return to context than did SD rats (p < 0.05). Importantly, we observed that the differences in the two strains behaviour upon return to context appeared to be related to their quite different patterns of coping behaviour. The results of the current study indicate that preclinical between-strain comparisons potentially have much to offer in regard to understanding the basis of resilience to social stress.

Physiological stress responses in the warm-water fish matrinxã (Brycon amazonicus) subjected to a sudden cold shock

The present work evaluated several aspects of the generalized stress response [endocrine (cortisol), metabolic (glucose), hematologic (hematocrit and hemoglobin) and cellular (HSP70)] in the Amazonian warm-water fish matrinxã (Brycon amazonicus ) subjected to an acute cold shock. This species farming has been done in South America, and growth and feed conversion rates have been interesting. However, in subtropical areas of Brazil, where the water temperature can rapidly change, high rates of matrinxã mortality have been associated with abrupt decrease in the water temperature. Thus, we subjected matrinxã to a sudden cold shock by transferring the fish directly to tanks in which the water temperature was 10oC below the initial conditions (cold shock from 28ºC to 18oC). After 1h the fish were returned to the original tanks (28ºC). The handling associated with tank transfer was also imposed on control groups (not exposed to cold shock). While exposure to cold shock did not alter the measured physiological conditions within 1h, fish returned to the ambient condition (water at 28º C) significantly increased plasma cortisol and glucose levels. Exposure to cold shock and return to the warm water did not affect HSP70 levels. The increased plasma cortisol and glucose levels after returning the fish to warm water suggest that matrinxã requires cortisol and glucose for adaptation to increased temperature.

Letter to a dead playwright : daily grind, Vicki Reynolds, and archive fever

’Nothing is less reliable, nothing is less clear today than the word “archive”,’ observed Jacques Derrida in his book Archive Fever: a Freudian Impression (1996). This paper reflects on the unsettling process of establishing (or commencing) an archive for the Melbourne Workers Theatre, to form part of the AusStage digital archive which records information on live performance in Australia. Glenn D'Cruz's paper juxtaposes two disparate but connected registers of writing: an open letter to a deceased Australian playwright, Vicki Reynolds, and a critical reflection on the politics of the archive with reference to Derrida's account of archive fever, which he characterizes as an ‘irrepressible desire to return to the origin, a homesickness, a nostalgia for the return to the most archaic place of absolute commencement’. Using Derrida's commentary on questions of memory, authority, inscription, hauntology, and heritage to identify some of the philosophical and ethical aporias he encountered while working on the project, D’Cruz pays particular attention to what Derrida calls the spectral structure of the archive, and stages a conversation with the ghosts that haunt the digitized Melbourne Workers Theatre documents. He also unpacks the logic of Derrida's so-called messianic account of the archive, which ‘opens out of the future’, thereby affirming the future-to-come, and unsettling the normative notion of the archive as a repository for what has passed. Glenn D’Cruz teaches at Deakin University, Australia. He is the author of Midnight's Orphans: Anglo-Indians in Post/Colonial Literature (Peter Lang, 2006) and editor of Class Act: Melbourne Workers Theatre 1987–2007 (Vulgar Press, 2007).

Everyone’s life is so different : the experiences of young Australian adults who return home

The article focuses on the experiences of young Australian adults who return to their parent's homes. It cites several factors that lead young people to return home such as unemployment, divorce and parenthood. It uses qualitative interviews of 22- to 30-year-olds as basis of young adults' experiences. It argues that the decision of returning home is not a failure, but a positive choice in living arrangement.